低剂量静脉瑞芬太尼潜伏期镇痛联合水中分娩在分娩镇痛中应用.docVIP

低剂量静脉瑞芬太尼潜伏期镇痛联合水中分娩在分娩镇痛中的应用 　　【摘要】 目的：观察自潜伏期静脉自控泵注低剂量瑞芬太尼联合水中分娩用于全程分娩镇痛对产妇和新生儿的影响。方法：选择笔者所在医院2013年10月-2014年10月收治的阴道分娩初产妇120例为研究对象，随机分为四组，每组30例。A组患者未行镇痛处理，B组单纯静脉自控泵注低剂量瑞芬太尼0.02 μg/（kgmin），C组静脉自控泵注低剂量瑞芬太尼0.02 μg/（kgmin）联合水中分娩，D组单纯静脉自控泵注瑞芬太尼0.04 μg/（kgmin）。分别观察在给药前、宫口开至3 cm、5 cm及宫口开全（10 cm）时患者的宫缩疼痛视觉模拟评分（VAS），并于上述各时间点抽取患者外周静脉血检测β-内啡肽（β-EP）的浓度，记录产妇的不良反应发生情况（低SpO2、心动过缓、恶心呕吐）及产后2 h出血量、瑞芬太尼使用总量，记录新生儿出生后1、5、10 min的Apgar评分和四组新生儿的纳洛酮使用率。结果：三组分娩镇痛产妇的VAS评分均低于A组，外周静脉血β-内啡肽的浓度均明显低于A组，差异均有统计学意义（P8分。结论：静脉泵注低剂量瑞芬太尼联合水中分娩能明显减少静脉分娩镇痛药的总使用剂量及产后出血，且不影响新生儿的Apgar评分 【关键词】 水中分娩； 瑞芬太尼； 静脉分娩镇痛 中图分类号 R714.3 文献标识码 A 文章编号 1674-6805（2016）25-0001-03 【Abstract】 Objective：To observe the influence of low-dose Remifentanil PCIA analgesia from the incubation period combined with water birth in labor analgesia on puerperae and neonates.Method：One hundred and twenty cases of vaginal delivery primipara admitted to our hospital from October 2013 to October 2014 were selected as the objects and randomly divided into four groups：A group was given no labor analgesia，B group was given controlled intravenous infusion of low-dose Remifentanil of 0.02 μg/（kgmin），C group was given controlled intravenous infusion of low-dose Remifentanil of 0.02 μg/（kgmin） combined with water birth，D group was given controlled intravenous infusion of Remifentanil of 0.04 μg/（kgmin）.The visual analogue pain score（VAS） was observed and the peripheral venous blood were sampled to detect the serum concentration of β-endorphin（β-EP） pre-administration and at the time of cervix was open 3 cm，5 cm， 10 cm.The side effects，postpartum 2 h bleeding，total usage of Remifentanil of puerperae and the neonatal Apgar score 1 min，5 min，10 min after birth as well as the usage rate of Naloxone among the four groups were recorded.Result：Compared to the A group，puerpants in other three groups had lower VAS scores after analgesia and lower concentration of peripheral venous blood β-EP，the differences were statistically significant（P 　　【Key